149 comments:

I want to make sure I have this right. Are you claiming that the scientists at UCSF who are looking into the risks and bennifits of CT scans are more interested in saving money for the system than they are in providing the information for us to make good helath choices?

What a coincidence. First we got the prep news from the press that maybe women didn't need so many mammograms, and then the Dems started talking about reducing mammogram coverage. Now we get the prep news that CT scans cause cancer...in two or three weeks we'll learn that Obamacare finds CT scans unnecessarily risky.

Yes, Larry, if you haven't figured it out yet, the press, which works for Obama, lies to us, for him.

This is the problem with a giant political intrusion into healthcare: Now every single decision will be viewed as a political maneuver instead of a scientific or medical decision. Politics and science: Two great tastes that taste like shit together!

(Okay, okay. Politics always tastes like shit. All the more reason to not heap any more on our plates.)

Good non sequitur. I did not ask about the press. I asked about the Scientists who are doing us the service of doing this research.

Statistics show that those who recieve the most healthcare do not live longer. that is a good indication that some of what we do is counterproductive. Wouldn't you like to know what is and is not effective?

The whole population's statistics may indicate a problem with using any remedy or diagnostic tool other than asprin and head bumps. But NO ONE who is the patient cares about these statistics. He/she says what do I need now, not what is the percentage of people who will suffer cancer from radiation someday if they are now treated so that they live that long. You could argue that statistically every third person should be shot, or killed by a unexplained Pandemic, and then all will be better off in so many ways. These are the latest version of Nazi Eugenics freaks dressed up as educated caring people.

"In a separate paper, epidemiologist Amy Berrington de Gonzalez and her colleagues at the National Cancer Institute constructed a computer program to estimate the risks associated with CT scans. They concluded that about 29,000 future cancers could be related to CT scans performed in the United States in 2007. "

Estimated deaths, on paper.Not unlike the estimated temperatures in Climategate.

It's not a number they can even know, it's an estimate extrapolated from older data on presumed risk.

Is it real risk?Do small doses of radiation really add up linearly even when CT scans are done over many years?Who says so?

No one knows for sure, but it's damned certain someone will estimate it firmly.

There is no treatment that is risk free, aspirin included. You cannot make a good decision about which treatment or diagnostic tests to use absent risk benefit analysis. How would you suggest we make these decisions?

"Statistics show that those who recieve the most healthcare do not live longer. that is a good indication that some of what we do is counterproductive. Wouldn't you like to know what is and is not effective?"

Can you please elaborate on your first sentence because it doesn't really make any sense. What does "the most healthcare" mean exactly? Preventative care? Care after a disease has been diagnosed and treated? What?

We've always (or for a long time at any rate) known that x-rays are bad.

Bad. Bad. Bad.

But we still get them done for diagnostic reasons. We have the dentist x-ray the heads of our small children when they aren't even sick and have no suspected problems. It's just routine. And all the while the nurse or x-ray tech is wearing a lead (which is also a bad thing for you... lead...) apron because x-rays are bad, bad, bad.

CT scans aren't gotten for the pure fun of it, frivolously.

Nor are mammograms. No woman gets one of those because it's fun to have your boob pinched.

And strangely, although CT and other imaging have markedly increased over the last 50 years, "New diagnoses for all types of cancer in the United States declined almost 1 percent per year from 1999 to 2006 and cancer deaths dropped 1.6 percent per year from 2001 to 2006."

One of the more common questions about MRI vs CT scan asked by patients is what's the difference between CT and MRI? Why should I have a CT instead of an MRI? Or why should I have an MRI instead of a CT?

These are very common questions and imaging professionals like us have the answers. The answers come from 2 other very important questions....

1. What part of the body does your doctor want to see? AND

2. What's the reason for the exam?

CT Scan does not show you tendons and ligaments very well at all; at least not yet. MRI is the best choice for that. Tendons and ligaments around the shoulder and knee are best seen by the physics used in MRI. This is due to the density of the tissues that compose the tendons and ligaments.

Spinal cord is best seen by MRI for the same reason. The density of the spinal cord and the composition of it is such that MRI physics can show it to us much better than CT.

There are also reasons why CT is the exam of choice over MRI. It is the preferred modality for cancer, pneumonia, and abnormal chest x-rays. Bleeding in the brain, especially from injury, is better seen on CT than MRI. But a tumor in the brain is better seen on MRI.

If you've been in an accident, organs can get torn or damaged. CT shows organ tear and organ injury quickly and efficiently. Broken bones and vertebral bodies of the spine are better seen on CT but injury to the spinal cord itself is displayed on MRI far better than CT.

CT is far superior at visualizing the lungs and organs in the chest cavity between the lungs. MRI is not a good tool for visualizing the chest or lungs at all.

Once again we are trying to address population issues versus individual health choices--we epidemiologists can always tell you what your risk is in terms of the general population; but we CANNOT tell you what your individual risk is. I can tell you that 10 in 100K will die from whatever; I can't tell you WHICH ten. Which is why the individual ultimately has to make the decisions.

After the fraud that is Climategate was exposed, I am having a much tougher time believing any scientist now. It's all boiling down to faith these days and frankly what with all the emphasis on reducing costs in health care now I don't have much in anyone who says we don't need this kind of preventative care.

Wow, are people seriously proposing that X-Rays DON'T cause cancer? You all do realize that CT Scans use ionizing radiation, not magic, right?

There is some evidence that exposing precancerous growths to ionizing radiation makes them cancerous. In other words the very tools we use for diagnosing a disease may be causing and/or contributing to it.

(I think many also miss the point of the article which is that the way CT Scans are performed can result in 4x or more radiation exposure. It's also known that some early CT Scanners could be calibrated incorrectly resulting in massive doses of radiation which killed people. This isn't myth and presenting it as such is being just as moronic as Al Gore.)

From the actual NEJM paper cited:"Most of the quantitative information that we have regarding the risks of radiation-induced cancer comes from studies of survivors of the atomic bombs dropped on Japan in 1945.25 Data from cohorts of these survivors are generally used as the basis for predicting radiation-related risks in a population because the cohorts are large and have been intensively studied over a period of many decades, they were not selected for disease, all age groups are covered, and a substantial subcohort of about 25,000 survivors26 received radiation doses similar to those of concern here — that is, less than 50 mSv. Of course, the survivors of the atomic bombs were exposed to a fairly uniform dose of radiation throughout the body, whereas CT involves highly nonuniform exposure, but there is little evidence that the risks for a specific organ are substantially influenced by exposure of other organs to radiation.

There was a significant increase in the overall risk of cancer in the subgroup of atomic-bomb survivors who received low doses of radiation, ranging from 5 to 150 mSv27,28,29; the mean dose in this subgroup was about 40 mSv, which approximates the relevant organ dose from a typical CT study involving two or three scans in an adult.

Although most of the quantitative estimates of the radiation-induced cancer risk are derived from analyses of atomic-bomb survivors, there are other supporting studies, including a recent large-scale study of 400,000 radiation workers in the nuclear industry30,31 who were exposed to an average dose of approximately 20 mSv (a typical organ dose from a single CT scan for an adult). A significant association was reported between the radiation dose and mortality from cancer in this cohort (with a significant increase in the risk of cancer among workers who received doses between 5 and 150 mSv); the risks were quantitatively consistent with those reported for atomic-bomb survivors."

So no more chest X-Rays? Or any imaging tests? Give me a break and let's recall all those microwave ovens too.

Talk about throwing the baby out with the bathwater. X-Ray machines in various forms are a great tool, but like any great tool they can be abused even if used properly.

The good news is that improved sensors have made it possible to greatly reduce the amount of X-Rays required. That doesn't eliminate the risk, but it does mitigate it. Despite that, there are radiologists who don't follow safety guidelines and machines which break and so forth.

I would suggest that "we" don't make those decisions at all, if by "we" you mean the corporate "we", i.e., the government.

The best course for "me" to take should be determined by me in consultation with my doctor. Together, we can fine-tune our assessment of risks and benefits in a way that statisticians and governments can't.

Of course, our assessment should be informed by good science concerning the risks and benefits, so the science itself, if done properly, is an unalloyed good. (Is that the point you're making?)

It is the application of scientific conclusions about net effects on populations to determine treatments (or coverage)for individuals that is problematic. Doubly so if/when the determinations are made as a matter of public policy by government actors that have lots of concerns in play that are unrelated to any individual's health.

They're just making projections, then, based on data from a non-parallel case (atomic bomb survivors, who faced fallout, a flood of neutrons from the burst itself, and other stuff not relevant to x-rays). Count me skeptical. CT scans have been around long enough for long-term studies. Find people who've had them 20 years or more ago and compare to those who haven't.

@ Larry Geater...One well paid and ethical MD after another who are seeing and treating individual patients should make those decisions individually. In the meantime do Real Science over years and double blind studies to keep the MD's up to date.The actual answer is to produce thru education a better class of patients who can think and therefore cannot be easily fooled by bad shyster MD's or by bad Shyster Scientists. Being awash in lies from the Government is the last way to solve this analysis of risks that they always pose to us as a Benthamite problem requiring the least good for many so long as the average good for all can statistically go up.

Minimaly. My point was that people act like these decisions are not made in a bureaucracy now. They are made in corprate bureaucracies. Some of these are easier to deal with than the government bureaucracy, some are more difficult.

How about when they are made by insurers who have concerns in play that are unrelated to any individual's health?

IMO, the interests of insurers are a problem, but a smaller one. They have their profits to see to, but government actors would have lots of other concerns on top of the financial ones. As a patient, I would rather have the government in the supporting role of keeping the insurers honest rather than the potentially oppositional role of deciding what health care services I should get. Partly that's because if I don't like my health insurer I can switch to another one (perhaps with difficulty, but not as much difficulty as switching governments). YMMV, of course.

@ Larry Geater...When there is a single payer government system, how many competitors with a the evil profit motive will there be? The government single payer has a motive too which is to stop losses and redirect as much money as possible to ACORN/SEIU/ Gov.Blago Type projects/ and the competition that could keep them honest is non-existant. How many Billions in useless earmarks were in the Spending bill passed last week by Speaker Pelossi? There was no competition to hold that slush fund down. And how many earmarks were in the Blue Cross/Blue Shield's budgets that faced actual competition? Trusting a government that also wants you to pay Trillions of dollars to a UN slush fund for their overseas buddies and Sosos's benefit is not rational in the world that we are living in.

I followed the links and ended up with a Chicago Trib story that summarized two separate stories regarding radiation exposure and cancer risk. And so how is this a death panel thing?

This blog post and many of the comments sound like demogougery to me. Yes, CT scans expose an individual to radiation and yes that should be considered as a potential harm in developing any recommendation regarding the routine use of a CT scan. Is that supposed to be controversial? So when another study comes out quatifying the risk of NSAID's (like ibuprofen) and kidney disease someone will suggest the government is trying to take away your medicines? c'mon folks calm down and get real.

And PS yes the second study was done by the National Cancer Institute. They have historically advocated for mammograms for women between 40 and 50. They have not changed that recommendation.

"They are made in corporate bureaucracies. Some of these are easier to deal with than the government bureaucracy, some are more difficult."

This hits on a key bit for me.

Corporate bureaucracy is assumed. Corporations are evil, sure, but at least we know them to be such and can complain accordingly. Plus, corporations are limited in their roles.

The trouble with the government is that it has its hands in so, so many places that the bureaucracy gets into every part of life, and is inescapable.Everything becomes tied to this. Which would be somewhat eased if there were very stringent safeguards against corruption and favoritism. But, quite to the contrary, this whole debate is flooded with massive amounts of graft, politicians brazen in looking the other way and filling their own pockets, and all the other signs that corruption is encouraged in the present proposals.

I do not want someone in charge of my healthcare who can know what religion I am, what race I am, who I voted for, how much I paid in taxes, how much and to who my donations went to, and every other part of my life.

Any time there is allowed/encouraged corruption there is hatred towards the poor and needy. When the rhetoric brings up the poor and needy as a moral claim, then the proposal isn't just foolish, it's pernicious and should be treated as such.

We are not in any danger of getting a single payer system. The proposed plan in congres now is a Bismark Plan. There has never been a case of a bismark plan evolving into a single payer system despite the hope of the left and the fears of the right. Several of the European nations that have bismark plans that had a public option have dropped them in the past couple of years.

You cannot make a good decision about which treatment or diagnostic tests to use absent risk benefit analysis. How would you suggest we make these decisions?

@ Larry.

I would suggest we make these decisions on an individual level in conjunction with our personal physician and not by government fiat directed by a bunch of anal bean counters who look at sick people as impersonal statistics to be manipulated.

Risk management is part of what I do for a living> Having your risk strategies dictated from on high and to have you treated as part of homogeonus group.....is NOT risk managment for YOU. For the government yes....but not for you.

The question to you is: Whose risk are we managing here? Hmmmmmm The patient or the government? Take your time.

Avoiding unnecessary radiation exposure does sound like a good thing. The article points out that a CT scan of the chest can be the equivalent of 100 X-rays or 440 X-rays. Assuming the scans produce the same resolution images, I'll take the 100 X-ray CT scan, please.

Plus a meathead I worked with demanded a CT scan because he had occasional sinus trouble. You could probably live with a stuffy head if the alternative was a brain tumor.

The liberal obsession with healthcare costs and junk science is a deadly combination. Once the government owns healthcare and can't afford to pay for it, the sollution will be to cut effective but espensive services like cat scans and replace them with new age junk or use junk science to justify not replacing them at all.

The government is not going to force you to buy their plan. As of today there will be no government plan. they are going to force you to buy a private plan of your choice. No insurence is the only prohibited choice.

Avoiding unnecessary radiation exposure does sound like a good thing. The article points out that a CT scan of the chest can be the equivalent of 100 X-rays or 440 X-rays. Assuming the scans produce the same resolution images, I'll take the 100 X-ray CT scan, please.

The resolution goes up with the dose and down with the patient size. Part of a radiologists job is to balance those, usually by creating protocols that are implemented by the CT tech (i.e. they create general rules not patient by patient. Did you think that we just shoot some people harder because we hate them?

@DBQ not trusting "the scientists" has a lot more implications than not trusting the last study. It means not trusting any study including the studies that led to CT scans and life saving drugs that some paranoid (or perhaps not--I think it is fair although perhaps not wise to be reflexively paranoid about the government) people are afraid they are going to lose. Science is a large institution with a history of self correction. It is also the only game in town unless you think casting bones, reading tea leaves or sacrificing virgins to the Volcano God are going to help you.

they are going to force you to buy a private plan of your choice. No insurence is the only prohibited choice.

My understanding may be out of date, but I thought "they" were going to force me to buy a private plan of my choice that meets government-imposed requirements. So the prohibited choices would include both "no insurance" and "unapproved insurance."

"Ya, let's give Hitler credit for programs that were in place before he was born."

Actually, we should give Bismark credit for Hitler. The programs that were in place before he was born were a necessary precondition thereof. The National Socialists were nevertheless quite proud to retain these programs, however.

"not trusting "the scientists" has a lot more implications than not trusting the last study."

Of course, but now science has screwed the pooch, by veering outside of their limited purview. As a result, what they say is not trustworthy simply because they say it. Not anymore. Too bad, but betrayal works like that.

The government is not going to force you to buy their plan. As of today there will be no government plan. they are going to force you to buy a private plan of your choice.

That is a lie. You are a liar.

The government is going to limit the choices that I have by telling the insurance companies what policies that they can offer. High deductible catastrophic policies or those with an attached HSA option will not be allowed.

The plan that the insurance companies will be 'allowed' to present will be dictated by government and therefore IS a government plan.

THAT IS NOT CHOICE.

No insurence is the only prohibited choice.

I think you need to look up the definition of choice. The government has NO right to tell me that I must purchase something.

Yes, there will continue to be insurance regulations that mandate minimum coverages. So you will be prevented from buying insurance that does not meet these standards. There will be no prohibition preventing insurers from offering better plans for those who can afford them.

@Pogo and DBQ, I can't help but think you are overstating your distrust of science for rhetorical purposes. Any other reading seems insane to me. It is quite possible to acknowledge bad faith in some particular aspect of the enterprise and not overturn the whole thing. It could be that I'm not understanding where you are coming from but what you are saying seems paranoid and bizarre.

Did you think that we just shoot some people harder because we hate them?

No, because you're careless and/or stupid:

Radiation Overdoses At Local Hospital Caused By Mistake October 13, 2009 (by Horatio Algren) According to reports a mistake at Cedars-Sinai Medical Center traced to radiation overdoses. According to hospital officials at the Cedars-Sinai Medical Center an error was made when resetting a CT scanner, which was used as a new practice for a specialized type of scan in diagnosing stroke patients. The machine was reset to override the pre-programmed instructions to help doctors gain more useful data, with the scan. This would allow them to analyze disruptions in the blood flow to brain tissue.

In a statement the hospital officials have stated the CT machine resetting resulted in a higher than anticipated amount of radiation. According to reports the higher amount of radiation was eight times the amount that it should have been during the CT scans for stroke patients. The programming with a different protocol for the CT brain perfusion scan, subjected every patient that was given this tests an overdose of radiation.

The error was brought to the hospitals attention after a patient alerted them they had began losing hair after having the scan preformed. The mistake went unnoticed for 18 months and after a review of hospital records there have been 206 patients that could have been affected.

According to reports approximately 4 percent of the patient’s have had patchy hair loss and some with reddening of the skin. The Food and Drug Administration after the radiation overdoses has issued an alert warning hospital’s to check CT scan protocols.

Arcata, California, 2008:

The parents stated that they were in the CT suite and observed the entire procedure. They claim that because their child did not lie still on the CT table, the technologist took 151 CT scans in a 65-minute period, at which time the parents insisted that the procedure be halted. A hospital radiologist who reviewed the images ordered an additional CT exam, the parents stated, and a different technologist took an additional 15 scans.

Two hours after the exams were completed, the boy developed radiation burns under his eyes on the bottom half of his face. The parents met with hospital managers when they returned the child to the hospital and said they were told not to be concerned about the visible burns on the child's body and face.

Um, put me down as favoring anything which increases my knowledge of "what is and is not effective".

Put me down, also, as wondering about concurrences.

The problem here is that someone on the Right, not the “Far Right”, please, came up with a phrase that caught people’s attention & the Dems & Libs & their apologists in the MSM are having a hissy fit because they feel that only they can come up with these types of phrases & anyway she gave the whole game away & gave rationing the bad name it deserves.

As Prof A asks, would you prefer the euphemism “Life Panels”? You know, like the Nazi Death Camp doctor who claimed at Nuremburg that when he made his choice about the Jews who came before him at the train siding & & sent some of them to the work part of the Death Camps he was "saving" lives.

Life panels. That make you feel any better?

(Aside, how come we can use the term "Death" for those camps when we know that "arbeit macht frei"?OK, perhaps I’m following Godwin’s Law!)

Yes, there will continue to be insurance regulations that mandate minimum coverages. So you will be prevented from buying insurance that does not meet these standards. There will be no prohibition preventing insurers from offering better plans for those who can afford them.

Listen up, moron.

I don't want a "better" plan. I don't need the minimum standards devised by government mandate.

I want a "lesser" plan. I don't NEED OR WANT to have coverage for many of the bells and whistles that the government insists I have.

Maternity coverage...nope not going to happen

Substance abuse counseling....nope

Small deductible....no thanks...I can pay out of pocket.

20/80 co pay for ordinary doctor's visits....I can pay for the 2 times a year that I see the doctor.

Drug coverage....no thanks...I don't take any drugs.

Acupuncture, aromatherapy blah blah blah.

I want a less than minimum standard policy that covers just a few items and catastrophic illness. That is MY choice.

That's all I need and all I want. WHO the FUCK are you to decide for me?

I definitly do not need maternity coverage since I am as a man unlikely to become pregnant. But insurance should cover this. It should not cost women more for their coverage. We all benifit from their having good prenatal care, and spread across the population it is a small cost.

As a democratic republic we can decide on our level of services and taxation to supoport those services. That is the price you pay for being a citizen.

FLS, the CT things you cited don't really come under the category of "normal use is bad for you" or "normal disclosure is consistent with telling people to ignore visible burns." Sounds like some pretty obvious but likely localized and actionable problems. I realize that a technician isn't a doctor, but if a kid won't be still for 150 tries and an hour... maybe you get some help *before* then?

I mean... some things should be a clue, you know? Like when the technicians are behind a glass in a protective room. Big clue. Or wearing a lead vest or standing behind a shield. Wow. How hard is it to realize that it's possible to get over exposure?

Look, following his muse, Slick Willie, Larry is saying "Depends on your definition of 'choice' ”.

The Godfather always gave you a choice: accept his offer or....

The One is going to give us all an insurance choice that we can't refuse.

Reducio ad Nazium has been given a bad name by Godwin. What about reductio ad Godfather (Compater?)?)

Actually, to hell with Godwin! Dr Goebbels would be proud of the MSM because they robotically present the Obamacare version as a true choice (as of the moment) & treat your refutation as "never happened".

Trust the drafters of whatever is going around now on paper, if anything.

Trust the Compassionate ones who preach to us about our need to provide for the poor. As well as the tired & the huddled masses yearning to breathe free.

Trust the Economists who say that Socialism need not cause rationing, even tho it always has up to now, because, unlike the past, Obamahopeychangeyhealthcare will be administered by non-greedy folks who will have your best interests at heart. Of course since we can't X-Ray their hearts, we'll have to take that on faith, OOPS, that sounds like Sarah Palin. Let me rephrase that gurgle, gurgle....

I definitly do not need maternity coverage since I am as a man unlikely to become pregnant. But insurance should cover this.

Why? Why should you pay for something that you are not likely to use or will ever ever use?

I'm a woman, obviously, and not likely to get pregnant unless there is some sort of biological miracle. I also won't need an abortion. I don't use drugs. Why should I be forced to pay for those things?

I know what the answer is to these questions. Do you?

I can afford to pay out of pocket for my basic medical costs. I can afford to pay for moderate medical costs. I can afford to pay for even mildly expensive procedures.

Why should I be prevented from putting the money into a Medical Savings account (HSA) instead of funneling it to the government or an insurance company? Risk management for me indicates that I not lose the opportunity to invest and save the money instead of paying for things I don't need..

I can't afford catastophic costs and that is the only thing that I should be insuring against. This is what risk managment and insurance is all about.

I know what the answer is to these questions. Do you?

It should not cost women more for their coverage.

I'm with Synova. Why not? If they want to buy the coverage for those items, why shouldn't they pay more?

Insurance is all about risk managment and what YOU need to insure against and what risks YOU want to take.

If I drive a Mercedes and you decide to drive a 1972 Pinto, why should you pay the same insurance premium as me?

If I decide to only buy liability insurance on my Mercedes and forgo the collision and comprehensive because I can pay for repairs....why is it your business?

Chris...No one distrusts science from a school with a tradition of academic excellence. In Georgia that would mean Emory and Georgia Tech. We know these men and women personally and by reputation to be dedicated to the pursuit of science. BUT today we are awash in faked science by men who have sold their souls and their academic credentials for the first get rich quick scheme that offers them 30 million pieces of silver. Therefore science from unknown Pile it Higher and Deepers must first be tripple checked before we give it the benefit of the doubt anymore.Meanwhile all of the Popular Propaganda outlets keep on pretending that every Phd is a real scientist rather than a counterfeit scientist to give this scam cover. Which side are you on?

Yes, there will continue to be insurance regulations that mandate minimum coverages. So you will be prevented from buying insurance that does not meet these standards.

When you say "continue," do you mean to suggest that the proposed legislation would not change existing regulations concerning minimum coverage? I was under the impression that the proposed legislation would establish new standards.

@DBQ the thing is, health insurance is already like that. I would love to be able to buy a policy similar to the one you mention but the industry is already regulated to a point where that isn't possible. I think the best be might be to take advantage of a HSA and cut a deal with your doctor to pay something based on medicare reimbursement rates. And get the best catastrophic plan you can find.

Willful deceit, or wingnut blogs turning brains to mush. I never can tell, although I think it's the latter. None of the proposals ever amounted to more than a million or two people on the public option, and when Ben Nelson and Joe Aetna get their way there will be no public option and these clowns will still be running around screaming government health care! and socialism!

You NEVER "trust" scientists! That's the whole point of science! That's why valid science is reproducible! Good science never begins with "trust me..." You have to show how you arrived at your conclusion and your experiments need to be reproducible. Where did this absurd, stupid notion of science-as-doctrine come from?

Maybe "trust but verify" is a better approach. But as a person with a great interest in science, I trust no one. That's as it should be.

As a democratic republic we can decide on our level of services and taxation to supoport those services. That is the price you pay for being a citizen.

I agree with this in principle, but I don't think it describes the proposal. The proposal, as I understand it, is to require me to buy insurance I don't want from a private company so that the private company can subsidize services to parties deemed by politicians to deserve coverage, all while allowing the politicians to claim that they haven't raised my taxes. What you're describing above is a system under which the government would transparently tax me in order to provide a transparent subsidy to women of child-bearing age that would help them add a "pregnancy rider" to their insurance policies. You may think the difference is trivial, but I don't.

synova -- I picked the first one because the doctor deliberately overrode the factory settings, because as an MD, he knew better than the manufacturer what the proper dose should be. Then as an all too human human being, he neglected to restore the original settings. And no one else ever -- in 18 months -- bothered to check the settings. This contradicts bladedoc's assertion of careful dose selection every time.

In terms of doses: CT scanners have been in hospitals for some 40 years. My expectation is that part of 40 years of improvements would have been to reduce the dose per CT scan while maintaining the same resolution.

Our point of dissagreement is that I find the argument made on this subject by Hayek in "The Road to Serfdom" (one of the most influential anti-socialist books of the 20th century)pursuasive. He said:

"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance - where, in short, we deal with genuinely insurable risks - the case for the state's helping to organize a comprehensive system of social insurance is very strong... Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken,"

You are confident that you can eliminate risk for yourself and that those who do not ahave a oral failing that you should not pay for. Hayek and I disagree.

@traditionalguy and Palladian. You can trust the institution of science without trusting individual scientists. That's the beauty of science. It has a proven record of sooner or later casting off the bullshit. This doesn't mean there isn't going to be a lot of bullshit and politics and of course long before climategate it was obvious climate science was extremely political. Great institutions have the ability to recover from the evil that men do. Popper used to say the great thing about western liberal democracy wasn't that it put the right guys in power but rather that it kept the ability to get the wrong guys out of power. I think science is like this as well.

garage, will the coming People's Beneficent Universal Healthcare (PBUH) pay to repair the tendinitis you're getting from carrying all that heavy water for the Democrats all the time?

Are you kidding? Democrats are completely fucking worthless. Most are bought and paid for just like Republicans, and the one's that aren't bought and paid for are spineless jellyfish. Still struck how clueless conservatives are (again, deceit or ignorance?) on the biggest gift insurance companies being handed to them in decades is called "government run healthcare", or "socialism". NOTHING will ever come out of the senate that doesn't have a nice wet stamp of approval from the insurance companies who pay for the legislation that suits them.

That's all well and good for now with the HSA option. However, the government plan is to prohibit insurance companies from being able to offer that option

And there are plans that allow you to pay for coverage that would be limited to XX dollars per prodedure. For example up to $25,000 for a surgery. $500 for an emergency room visit. $50 per office visit etc. Yes, they aren't comprehensive coverage and not very desirable, but they are available. For now.

Even CNN says so. They may have changed some of this since July but who the fuck knows since the bill is unreadable, the Senators and Reps won't read the bill and Larry says it doesn't matter that no one should bother reading it.

The Senate bill would require coverage for prescription drugs, mental-health benefits, and substance-abuse services. It also requires policies to insure "children" until the age of 26. That's just the starting list. The bills would allow the Department of Health and Human Services to add to the list of required benefits, based on recommendations from a committee of experts. Americans, therefore, wouldn't even know what's in their plans and what they're required to pay for, directly or indirectly, until after the bills become law.

And as to garage's misdirection and purposeful misunderstanding (I'm being charitable and assuming it isn't sheer stupidity) we are not talking about the Government option. I'm talking about the government mandates on private insurers telling what they can and can NOT offer.

When they do this it is the same thing as a government option....just cloaked a different way.

PJ in his 4:22 post has it exactly correct. And is the answer to my questions to Larry, which he obviously doesn't know.

The entire plan is to shift the cost of subsidizing other people's health care onto people like myself by forcing me to buy coverage that I don't want, don't need. Is is a taking of MY money to give to others that the government has deemed more worthy. Forcing the young, the healthy and those who don't need to buy coverage to subsidize and provide free coverage for the 'chosen ones'.

@DBQ I'm not against a Canadian style system but I really don't want to get into a tit for tat on that issue. My desire is that they deregulate to the point where the market actually behaves like a market and the consumer is the individual receiving care. That is my ideal. If we can't get there then I have no problem with a single payer system so long as it doesn't crowd out private entities that want to compete at the high end. I realize this may not be possible but I think the system we have right now is pretty terrible. I do agree that the proposed fix seems worse though.

My desire is that they deregulate to the point where the market actually behaves like a market and the consumer is the individual receiving care. That is my ideal. If we can't get there then I have no problem with a single payer system so long as it doesn't crowd out private entities that want to compete at the high end. I realize this may not be possible but I think the system we have right now is pretty terrible. I do agree that the proposed fix seems worse though.

The problem is that the "solutions" are far worse, and, in particular in terms of the patient and his/her doctor deciding courses of treatments.

Canadian (or UK) Style health care means that the government really is the party deciding all these questions, typically from a cost standpoint.

The "public option", as well as expanding Medicare and Medicaid, inevitably lead to cost based rationing. There is no way around it.

And as has been repeatedly pointed out, the proposed regulations of what policies are allowed to be issued will inevitably lead to those with little use for health care to pay much more for those who use health care a lot.

People keep talking about how bad the current system is. But the reality, contrary to wingnut and DNC talking points, is that a large majority in this country are satisfied with their current health care insurance. And that statistic is much more instructive than all the anecdotal horribles that we constantly hear about. Yes, there are problems. But the current proposals are going to make our current system look like nirvana.

I doubt that Hayek was thinking that society should include in catastrophic sickness, accidents or disaster ASSISTANCE

-paying for abortions-pregnacy-viagra-sex change operations-drug abuse counseling-100% coverage for office visits-free bandaids and covering every little scratch and pimple to the extent that people have no responsibility for themselves.

"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision

Assist is the operative word here. Assist doesn't mean that we rob from one group to provide free goodies for others. Assist assumes that you are helping too and not just taking.

I also doubt that he would approve of forcing others on pain of penalty or jail to pay for the cadillac coverage of the above.

And NO I don't think I have a moral reposibility to bend over and be hosed by the government for those purposes.

The road to serfdom is when the government takes over control of every aspect of our lives, plans everything for us and we are not allowed any choices.

If I want to contribute to help those less fortunate get surgery or whatever, then that is what charity is for. There are plenty of organizations that are set up for these purposes.

To take my money for those purposes against my will is Socialism and out and out theft.

@Bruce Hayden. I'm not so worried about cost based rationing unless it crowds out people providing higher end care. Imagine a world without insurance. There, cost based rationing just means not being able to afford treatment. I don't see why this is such a big problem. There are plenty of things I want that I can't afford. The question isn't rationing so much as could you buy the care you want but for the existence of some government plan.

"But, at the same time you know what's exactly in the bill and precisely how it will impact you and your money?"

I get my information on this from professional publications and people who are paid to try to read the bill and decipher what ramifications it will have on myself and my industry. I get daily updates from several sources on my email.

I also know how these proposals, that we know of so far, will impact my money....and my client's money, because this is what I do.

Base on economics and historical parallels the ramifications of the government proposals are clear and frightening.

Chris..."Science is not an institution. Various Universities are institutions with an investment in the past, present and future. These new cadres of counterfeit scientists have no attachment with the past, present and future so long as the milti-millions of dollars show up in their bank accounts from the UN Global Conspiracy. They are filthy Vichy Science, and they know it. We need the confirmation from our own opinion leaders in society that Vichy Science is not science at all before we trust any science anymore. When will the real scientists throw the Vichy scientists out publicly? Neutrality of silence is not an option they can afford. So where do you come down of this imitation of science by Algore's Gang?

DBQ: that's the rub. Will a particular health care bill have a chilling effect on the ability of people unconstrained by money to get the healthcare they want (or need as you put it).? This gets into he said/she said territory as libertarians will say any government intervention is going to put a drag on things. I'd be happy if the bill allowed a relatively free market at the high end. Also I understand the heuristic of the devil you know, I just don't think the devil we presently know is all that great.

@traditionalguy. I am a skeptic. This means that everyone hates me. As for science, I think it is an institution. In the end the scientific method underpins the enterprise and sooner or later the frauds get found out. Well, that's probably overstating it. I like to say that science isn't so much right than it is less wrong. Evil men are ubiquitous. I can think of no worse institution than one that relies on human goodness. The institutions that survive the test of time, and I think science is one of these, are those that have an innate ability to kick the bastards out. The scientific method allows for this.

When will the real scientists throw the Vichy scientists out publicly? Neutrality of silence is not an option they can afford.

This is a quandry for the ethical, 'real' scientists. I can compare it to my industry where people like Madoff and scandals like Enron cast a pall over everyone.

You can be the most ethical and hard working person in the financial industry, but when people get taken by annuity sharks, stock scammers and are lied to by their greedy advisors, it reflects badly on everyone.

The securities industry still needs to do much more house cleaning and so does the scientific community as well.

By trying to cover up and sweep the scandal under the rug, they are doing themselves no good. People will not begin to trust again until there is some self policing in the industry. The media isn't helping either by attempting to distract and sugar coat the story.

Chris...That was a very discrete and wise answer. But will the Science Insitution and yourself when you hold your next annual convention appoint a diciplinary committee that can issue a public rebuke to the Vichy Science Regime that falsely says CO2 is a pollutant and risk a cut off of all those billions of grant dollars they pay with? The answer will require a strong and bold leadership that is willing to risk taking a stand that is neither discrete nor wise for them personally. But if that doesn't happen, then Science is not an institution after all, is it?

But this has nothing to do with your comment that given the choice between two doses of radiation you'd take the lower one. That's not the choice and the response is a non sequitor.

The reason that CT scan dose varies from person to person is based on patient factors, just like pain medicine. The fact that some people overdose does not negate the need for people to get different doses.

The amount of willful ignorance on this blog has become absolutely appalling.

Luckily, I get a kick out of correcting such blatant misinformation. How could I not, when the alternative is to allow fact-free propaganda free reign to contribute to so many deaths?

Someone around here has to have a conscience.

Here are some of the facts regarding the consequences of iatrogenesis - something the Althousians are apparently unfamiliar with, despite the fact that it's been with us since the dawn of medical practice:

Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten were considered major, and in 2% of the patients, the iatrogenic disorder ended in death. Complications were most strongly associated with exposure to drugs and medications.

In another study, the main factors leading to problems were inadequate patient evaluation, lack of monitoring and follow-up, and failure to perform necessary tests.

In the United State alone, recorded deaths per year (2000):

12,000—unnecessary surgery

7,000—medication errors in hospitals

20,000—other errors in hospitals

80,000—infections in hospitals

106,000—non-error, negative effects of drugs

Based on these figures, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Also, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).

This totals 225,000 deaths per year from iatrogenic causes. In interpreting these numbers, note the following:

*most data were derived from studies in hospitalized patients.

*the estimates are for deaths only and do not include negative effects that are associated with disability or discomfort.

*the estimates of death due to error are lower than those in the IOM report. If higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000.

What was willfully ignorant about my informing a community that uncritically accepts such bullshit statements as "presents the treatments as deadly" as a meaningful characterization?

You are just being a dumb, political asshole, Michael Hasenstab. I don't care what your name is or who knows your name. And guess what? No one else does, either. That doesn't mean a fucking thing. What is meaningful is that it got under your skin that I reminded everyone here of the importance of iatrogenic disease, something that not a single soul here seems to even comprehend.

Refute a single item quoted in the article, or by IOM or ISMP - if you even know who they are. Otherwise, just shut up, piss off and have a stab at someone who is either dumb enough or immoral enough (or apparently both) to entertain your willingness to diminish the importance of iatrogenic illness.

It will get harder and harder for you to pull the wool over the public's eyes with this bullshit. Not only the professionals who are trusted with the nation's heath have turned on you and your ilk, but so have their representative organizations. Some of us have an ethical obligation both to the best science available and to patient safety, and if you don't like that, you can go fuck yourself. Because if you can't respect that, then you've proven yourself irrelevant in the strongest sense possible.

If this is the best your side can offer, you guys have just relegated yourself to history. Oh, you may still have a win here, a win there. But your movement, now fueled by both ignorance and a lack of any ethical grounding, is dead.

No public will take what idiots like you say seriously anymore if this is what you have to offer.

What I'm angry about is the callous disregard that you have for patient safety. You should be kept far away from anyone seeking or attempting to provide medical treatment.

Why are you concerned about my dating life? You clearly don't know a thing about dating. Everyone who isn't a fat, bald, ugly, dumb loser (complete with a repulsive Bismarck mustache and squinty eyes!) knows that dates are arranged early in the week and carried out later.

But I've never been in a biker gang. Maybe your lifestyle is different. It certainly looks that way.

I can see that your time here is causing you to be frustrated. A positive strategy would be for you to avoid people and places that cause you to be frustrated.

Perhaps a healthy thing for you would be to find a blog where your are welcomed, listened to, and appreciated for your contribution.

Already have that. I also have blogs where I my contribution is valued precisely because people listen to different points of view. Apparently that is not a concept that you understand.

I don't come here because I like frustration. And I don't always vent. But when I do, it's because (especially now), I receive satisfaction from pointing out when others are being moral pygmies and need to be put into their place for the danger that they would subject others to. I know that I have said what needed to be said, even if you are too proud and stupid to realize or even ponder the profoundly unethical, and even criminal nature of your wishes.

Good psychological health doesn't preclude a conscience - let alone acting upon it. If you think it does than you are clearly a sociopath. And that's not a good way to demonstrate a supposed state of psychological well-being on your part, Michael.

Dear Ritmo, Just to clear up any misunderstanding, I am not a physician, so people seeking medical treatment are not likely to encounter me.

I'm not in a biker gang, either. I just wear protective clothing when I ride because I believe in wearing protective gear.

I hope that this article helps you with your frustration and anger issues. I really do care about your well being, and even though you've called me names, I understand that it's just your anger talking, and that you don't really mean it.

Ritmo...That is a good point about medical malpractice. Why that has to be dealt with by eliminating medicine by MDs and replacing it with medicine by bureaucrats with rigable computer giving orders is not so clear to me. Guess what, I am not in favor of tort reform sheltering MDs and hospitals unless the damages cap is more realistic, say two million and not a quarter million. Still my own experience with fine MDs of great skill dedicated to their patients well being, and my own experience with Government Bureaucrats who ONLY work for themselves and delight in screwing up the public they are supposed to be serving leads me to be immune to the mirage of an Oneida Community of Free Government Medicine being pushed today.

Stop, TG. Why this willful misreading? Yes, I went off on a tear on Hasenstab, - and threw some political points in there for good measure - but that was not the point. There are good points the right wingers can raise about healthcare reform. This is not one of them. Dismissing the concept of iatrogenic illness is certainly not one of them. Did I get extremely pissed off when it seemed to me that someone did? You'd better believe it. Doctors should be the first to admit (and we usually are) when and that we don't know everything. And when a practice is shown to be more harmful than previously thought, you'd damn well better believe we take such findings seriously - no less than when a more effective one becomes evident. And that's all I'm looking for - the assurance that someone understands that.

Not every medical or scientific finding is fodder for political fucking football. As professionals we are in a tricky situation having to navigate eternally imperfect knowledge while still advancing the field and providing the best care that has been shown to exist. Most people respect that on some level. And I don't care if you do or don't (I've got my own complaints with health care, the medical profession, doctors, administrators etc.) but I put it into context and take my own health, those of my loved ones, and anyone who cares for my opinion seriously. If Althouse doesn't, that's one thing. But at least some of you should understand the gravity that comes with taking a finding so blithely and running with it so thoughtlessly as if it were nothing more than just another fucking opportunity for political fodder.

To do so is nothing other than immoral, in my book. Sorry, but that's how I feel. Surely you can respect that on some level.

Ritmo...We are talking past each other. I see medical care as a system of trained professionals and support personel being peer reviewed constantly that is self correcting over time. Then again in an outlying area far from a central facility such as Emory Medical School and its related facilities such as the CDC the standards are lower. But it is the pouring in of Congressional funded special programs for get rich quick schemes of Democrat businessmen where the highest level of medicine causing harm is now being experienced, because these guys are in it for pile of money only. Therefore, we need to stop that approach instead of letting it take over the whole medical world.

In going over this, I should probably apologize to Hasenstab, since he's probably a decent guy on some level and actually thought I was making a purely political point with no ethical, objective or realistic grounding in what I was saying whatsoever. Yes, that pissed me off. Sometimes passions can get the better of us, and sometimes they are just an expression of an important drive that is difficult for others to understand. If you want someone who doesn't care about the things that I responded to, then you will not find much input from someone who does have an ethical obligation regarding such matters. You will have the kind of robots and heartless bureaucrats that always get under Pogo's skin.

I mean, the way I see it, he over-reacts to a lot of things too. He sees totalitarian socialism in everything. But we are both passionate people who care about doing the right thing when it comes to these matters so, insofar as Hasenstab wanted to address my emoting, I should hope he understands the motivation. Again, heartless automatons who don't care about people's health might have responded differently, but I'm not one of them. Nor would I want my emotions to provide the appearance of getting the better of me. So there's a reason that I responded the way that I did and while Hasenstab might have (perhaps even sincerely) seen it as overdone, I don't regret what prompted me to get my point across in the way that I did.

Yeah. It certainly seems like we are talking past each other and the point of personal motivations doesn't necessarily have to intersect with the politics. Yes, medicine is a research-intense field, as we expect it to be, and the researchers don't care who funds what they're doing. The point, however, is that knowledge is, and will for the foreseeable future remain, imperfect. And insofar as the envelope is pushed to reveal that we have been doing something in an unsafe way, that point overshadows all this other stuff because it is one of the tenets of the health professions to take the research and the findings seriously and to channel them toward improved patient care - however that happens. All this right-left stuff is peripheral. I understand the right and left are fighting over issues of universality and access versus innovation, but come on. As long as the original post remains worth discussing, let's admit that the lay people are reading much more politics into this than the professionals would have, and for good reason. That reason is the fact that iatrogenesis is a serious issue and perhaps one that everyone here should appreciate as such before they go on and make it a political thing. It impacts professional integrity and we will pay attention to that long before any lay person, and especially any pundit or political hack will interpret it for how they immediately or confusedly understand it or how it impacts their own gain.

I had just read some of your blog, Michael - which I had never done before - including the November 14th post. I wish you the best for a continued and speedy recovery and apologize if my emotions seemed inappropriate or gave off more heat than light. Thank you for your kind comments.

As long as the original post remains worth discussing, let's admit that the lay people are reading much more politics into this than the professionals would have, and for good reason.

Welcome to Obamacare's first unintended consequence. Now every medical study will be viewed through a political lense as a possble justification for rationing.

And every researcher will be questioned about their programming practices, because if Climategate shows anything it's that researches without programming skills shouldn't be trusted with writing code. Speaking of which, the article in question didn't provide the link to the code. How do we know the CT risk analysis is computationally sound?

Speaking of iatrogenic illness--there's a huge problem in Canadian hospitals with infection control. With budget cuts, they are so short staffed and rushed that they skip handwashing. eewwww nationalized socialist care for ya right there

Iatrogenic disorders are a problem, but the numbers thrown about are pure bullshit.

"In the United State alone, recorded deaths per year (2000):12,000—unnecessary surgery7,000—medication errors in hospitals20,000—other errors in hospitals80,000—infections in hospitals106,000—non-error, negative effects of drugs"

What is an "unnecessary surgery"?Who sez so?Did they grab people off the street and cut off a perfectly good leg?Did they do appendectomies for no reason at all?Are surgeons doing 10000 fake procedures a month?Show me.Where are these false surgeries?Arrest these scam artists!

You cannot deny that there must have been a vast number of frontal lobotomies performed to have produced the mindless dreck & thbese fabricated tort lawyer stats so oft repeated as gospel by talkingheads in the MSM as well as by blog commenters.

Cut expenses: prevent unnecessary frontal lobotomies. At any age.

Also what does "20,000 other errors in hospitals" mean? Sounds like one of those entries which are used in parodies of double-entry bookkeeping: "other expenses: $1 zillion".

What is an "unnecessary surgery"?Who sez so?Did they do appendectomies for no reason at all?

Surgeries that simple weren't needed at all. Surgeries for misdiagnoses. A friend had an unnecessary appendectomy; they opened him up, his appendix was fine, but once they were in there, the took it out anyway.

There are also documented cases of patients being mixed up and the surgery being performed on each.

Without going into details, to cover his incompetent ass my wifes first obstetrician diagnosed her with things she simply didn't have. Fortunately, the next obstetrician saw right through it (though never said outright that the first one was an idiot--it was obvious to us that he didn't want to be involved in a lawsuit.)

I find the numbers quoted entirely believable and, if anything, on the low side. The infection rate in particular seems low to me based on a recent article about what just one hospital did to reduce their infection rates.

What amazes me, Pogo, is that when actual science is used and you disagree with the results, you claim it's bogus. This tells me that you simply don't care what legitimate science has to say. If you can't see the obvious differences between global warming science (or cold fusion science) and what the majority of scientists actually do, then you aren't trying very hard.

Another example of unnecessary surgery back in the 1970s and 1980s was abuse from certain MDs of the scary dx of lumps in women's breasts. At around 40 most women start to develop fibroid cysts. Doing a cyst removal or a breast removal were emergency dx to get the women into surgery and "save them from cancer". The real incidence of cancer was very small, and only a biopsy was needed for that. But that cyst removal paid for many luxuries for unethical surgeons.

What amazes me, Pogo, is that when actual science is used and you disagree with the results, you claim it's bogus. This tells me that you simply don't care what legitimate science has to say.

Perhaps Pogo is pointing out that it is impossible to discern from news accounts whether the science reported is "legitimate" or not. This is because the news media uses "science" to score political points and because they make little effort to research what they report if it fits their template. This is also true of politicians (See: Icepick [12:08].)

This does not even take into consideration the notable dissipation of the integrity of the scientific community due to internal politics and government money.

I dunno, Pogo. The point is that iatrogenic illness is real and serious, regardless of whether it actually works out to being the 3rd leading cause of death. Did you seriously wish to context that general point?

Some things are more obvious after the benefit of a large amount of time. In the past we might have been afforded the luxury of immediately available and obvious hindsight. But the fact remains: Iatrogenesis has been with us since antiquity and will be for the foreseeable future. Or did you wish to propose that Semmelweiss' findings were an anomalous development in the field?

Quite a few hospitals in Michigan would beg to differ.

Have you ever bothered to attend any meetings with your hospital's infection control committee? How often? How many patients are seen there? Someone's keeping some stats that I somehow think you're being disingenuous in quantifying - no matter how sincere you'd like us to believe is that sense of truthiness that's guiding you.

How about M & M?

You guys simply cannot be that dense and/or disingenuous.

Come on. Get off it. It's a vital sector of the economy, remember? 1/6th of it. It's not the Yale Skull and Bones club. Quit pretending you can shroud all these inconvenient things in mystery and authority.

I would like to point out that young guys driving motorcars is not quite the biological imperative, much less the biological default, from humankind's dawning, as women of the relevant biological ages being fertile and bearing children.

Also, when a woman past child-bearing age says she doesn't want to be in that pool anymore (in the context of complaining how burdensome that is), I always want to ask what insurance she's had since she reached adulthood--and more specifically, was it possible, her own pre-natal, natal and post-nat health care costs, and that of her infant's, in effect might have been subsidized in the larger sense of pool, back in those days?

I'm not assuming the answer--because the answer isn't always the same, to be sure. But often enough it is.

For the record, all of three of us--my husband, myself and my son--are substantial underusers (statistically speaking AND in individual terms) of both health care services and health insurance benefits. In terms of use charted against premiums paid, that's even more starkly true.